Provider Demographics
NPI:1003065913
Name:HARRIS, KELVIN LADON
Entity type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:LADON
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 PLANTATION VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4827
Mailing Address - Country:US
Mailing Address - Phone:912-576-1381
Mailing Address - Fax:
Practice Address - Street 1:USS TENNESSEE (SSBN 734)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:34093-2117
Practice Address - Country:US
Practice Address - Phone:912-573-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman